Zap of radiation to tackle leading cause of blindness

A clinical trial is using a robotically-controlled system to deliver highly-targeted, low-dose radiotherapy to treat patients with Wet Age-Related Macular Degeneration (AMD) in the hope of eradicating or reducing eye injections.

The nationwide study, funded by an NIHR and MRC partnership and led by clinicians at King’s College Hospital in London, is giving new hope to patients with the condition who until now have faced regular eye injections to preserve their vision.

In the one-off, non-invasive treatment, three rays of radiotherapy are beamed through the white of the eye to overlap at the macula. The therapy is delivered by an eye doctor using a robotically-controlled machine to ensure precision treatment. The total dose of radiation received by the body is about the same as a mammogram.

AMD, of which there are two main types (Wet and Dry), affects patients over 50 and is the leading cause of sight loss in the UK. The condition develops when the part of the eye responsible for central vision (the macula) is unable to function as effectively as it used to. Wet AMD – the more serious form of the condition – occurs when abnormal blood vessels form underneath the macula and damage its cells. Without treatment, vision can deteriorate within weeks or even days.

The standard treatment for Wet AMD involves the injection of drugs into the eye targeting a chemical called vascular endothelial growth factor (VEGF), which causes the condition. The injections do not cure Wet AMD but they help to preserve sight. It is anticipated that the new treatment will reduce or eliminate the need for further eye injections. Studies have already shown that in carefully selected patients stereotactic radiotherapy can reduce eye injections by about half, with many patients needing no further injections at all, and vision was better than in those who only received eye injections.

If proved successful, the new treatment will not only be more convenient for patients, who currently have to visit an eye clinic on a regular basis, but it will also be more cost-effective for the NHS. Each dose of the injection costs around £800 and needs to be repeated several times each year, whereas the radiotherapy treatment costs £1,250 but is required only once.

Tim Jackson, Consultant Ophthalmic Surgeon at King’s College Hospital, who is leading the trial, said, “Age-related macular degeneration causes more blindness in the UK than all other eye diseases combined. It is very common, and the risk increases with age so that by age 90 one in five people has the condition, with 600,000 affected in the UK.

“Initial results with stereotactic radiotherapy have been promising, with some patients experiencing a marked improvement in the quality of their vision, and some no longer requiring injections.

“As well as being a less invasive treatment, we anticipate it will result in better outcomes for patients by addressing the cause of the condition rather than just suppressing it with eye injections.

“Whilst not all patients are suitable for this new technology, for those who are we hope to reduce the burden of having to attend very regular clinic appointments. It should also save the NHS money – so it appears to be win-win.”

The randomised trial treats two-thirds of participants with the active treatment and one-third with a placebo. The standard treatment of eye injections is continued on patients throughout the trial, if they need it.

The trial is currently accepting patients, with about 20 participating hospitals across the UK. Patients can find their nearest participating hospital and details on whether they are suitable for the trial by visiting www.starstudy.org.uk. For further enquiries about the trial, patients can email kch-tr.star-study@nhs.net or phone 020 3299 1297.

The nationwide trial, which is funded by an NIHR and MRC partnership, is called the STAR study and builds on the success of the INTREPID study for Wet AMD.

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Notes to editors

1. King’s College Hospital NHS Foundation Trust is one of the UK’s largest and busiest teaching hospitals, training over 900 dentists, 750 doctors and 300 nurses every year. The Trust is recognized internationally for its work in liver disease and transplantation, neurosciences, cardiac, haemato-oncology, stroke, major trauma and ophthalmology. On 1 October 2013, King’s took over the running of the Princess Royal University Hospital in Bromley and Orpington Hospital, as well as some services at Beckenham Beacon and Queen Mary’s Hospital, Sidcup. The new enlarged organisation has over 10,500 staff and provides over 1 million patient contacts a year. 9,000 babies are delivered by our hospitals each year, and over 750 patients come to our Emergency Departments every day. For more information, please visit the website. You can also support the work of King’s College Hospital at www.togetherwecan.org.uk

2. King’s Health Partners Academic Health Sciences Centre (AHSC) is a pioneering collaboration between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts.

King’s Health Partners is one of only six Department of Health-designated AHSCs in England and brings together an unrivalled range and depth of clinical and research expertise, spanning both physical and mental health. Our combined strengths will drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity.

Our partnership brings together...

three of the UK’s leading NHS Foundation Trusts;

one of the top 30 universities in the world;

services provided over 225 locations, including seven hospitals and community and mental health centres;

2.2 million patient contacts each year;

31,000 staff;

25,000 students;

a combined annual turnover of £2.8bn.

... to advance health and wellbeing by integrating world-class research, care and teaching.

3. At King’s College Hospital we fundraise for the best in treatment, research and health education, leading-edge equipment and improving well-being in our communities. By uniting doctors, nurses, researchers and academics with our supporters and volunteers we can provide the best patient care that goes above and beyond. Find out more and support us at togetherwecan.org.uk

4. The project is managed by the Efficacy and Mechanism Evaluation Programme, an MRC and NIHR partnership, that supports later-phase “science-driven” clinical trials and evaluative studies, which seek to determine whether a health intervention (e.g. a drug, diagnostic technique or device) works and in some cases how or why it works. The programme is funded by the MRC and NIHR, with contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. www.nets.nihr.ac.uk/programmes/eme

5. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

6. The Medical Research Council has been at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Twenty-nine MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. www.mrc.ac.uk